Fungal Infection

Athlete's foot (Tinea pedis)


Did you know that athlete's foot is more common in men and tends to show up in the web spaces between the 4th and 5th toes. As well, studies show that 17 per cent of those frequenting swimming pools have athlete's foot. If not treated, athlete's foot can also spread to the bottom and tops of the feet.

There are four patterns of foot fungal infection:

A. Interdigital (between the outer toes)

A softening of the skin (maceration), scaling and some inflammation can be seen especially in the web space between the outer toes. This can also spread to surrounding skin surfaces.

B. Ulcerative

Also occurring between the toes, erosions and ulcers can develop as a result of secondary bacterial infection.

C. Moccasin type

This occurs when the infection becomes a very fine scaly eruption on the soles of the feet with some redness, which may extend to the side of the heel and at the front of the foot

D. Vesicular

An immunological response to the fungus, an eczema like reaction occurs in which small blisters appear, usually on the instep of the foot. It may also be seen on the hands.

Jock itch (Tinea cruris)

Jock itch is commonly seen in boys and men whose anatomy allows for a warm, moist environment which is ideal for fungal growth:

Often itchy and occurs in the groin creases (the scrotum is rarely affected), although it may spread to the upper inner thigh, buttocks and sometimes the lower abdomen.

More common in warm climates.

  • Shows as a red-brown scaly rash, sometimes with small blisters or pustules at the edge.
  • At times the skin may show a thickened appearance(lichenification) from rubbing and chronic scratching.

Ringworm (Tinea corporis)

Ringworm causes red scaly patches that are typically ring-shaped. It generally appear on the upper body, or the hands and feet. Beware that ringworm is sometimes inadvertently treated with topical cortisone creams, which change the appearance of the rash and may worsen the condition.

You are at risk for ringworm if you:

  • have a suppressed immune system
  • play contact sports or recreational activities
  • are the child of parents who have a fungal skin infection.
  • are genetically-predisposed to this type of infection.

Note that an uncommon but important variant is a condition known as Majocchi granuloma, which is a collection of small bumps or granulomas that can sometimes become warty-looking. This occurs when women shave their legs and the fungus becomes implanted in and around the hair follicle.

Face Fungus (Tinea faciei)

Look to your pet, which could be a source of face fungus. Also, a history of the hair being loose and easily pulled out from the skin is a clue. Other things to look for include:

  • Some scaling, which may be shaped like or form a ring.
  • A pustule (a small, round raised area of inflamed skin filled with pus) border
  • Frequent itch and burning, that may worsen in the sun.
  • Mild scaling to an acute inflammation with pustules in and around hair follicles. It may have the appearance of a bacterial folliculitis and can even mimic herpes, shingles, localized acne or, rarely, a dental sinus.

Note that farm workers are often at risk; and men can develop a condition called Tinea barbae, or "barber's itch" in the beard area.

Tinea Versicolor

This is a yeast type of skin fungus found on normal skin. If the skin is oily, warm and moist enough, it starts to grow into small "colonies" on the surface of the skin. In these colonies the yeast grows quickly and leaks out an acidic bleach, which changes the skin color. The patches are lightly reddish brown on very pale skin but they don't tan. Because of lack of any tanning, they look like white spots on darker or tanned skin. This is most often seen on the neck, upper chest, upper arms and back. There may be a fine, dry scale on it. Typically the white patches remains for months after the rest of the rash has disappeared.

  • This is seen as oval, or round patches on the upper arms and neck, and in children it may be seen on the face.
  • It affects both men and women, and is common in young adults and in seniors.
  • It is common in the tropics
  • It is often seen in those who have Cushing's disease. However, it is not more common in HIV infection.
  • Looks fine and branny (brown /powdery) and scale upon scratching the skin. The patches tend to join together in the centre.
  • The rash can be brown, red or white hence the name "versicolor.
  • On occasion, especially in young women, small red bumps or pus spots develop on the upper body, neck and sometimes the face.

Hair Loss Disorders

Hair loss (alopecia) affects men and women of all ages and often significantly affects social and psychologic well-being. Although alopecia has several causes, a careful history, close attention to the appearance of the hair loss, and a few simple studies can quickly narrow the potential diagnoses. Androgenetic alopecia, one of the most common forms of hair loss, usually has a specific pattern of temporal-frontal loss in men and central thinning in women. The U.S. Food and Drug Administration has approved topical minoxidil to treat men and women, with the addition of finasteride for men. Telogen effluvium is characterized by the loss of "handfuls" of hair, often following emotional or physical stressors. Alopecia areata, trichotillomania, traction alopecia, and tinea capitis have unique features on examination that aid in diagnosis. Treatment for these disorders and telogen effluvium focuses on resolution of the underlying cause.
Evaluating and treating hair loss (alopecia) is an important part of primary care, yet many physicians find it complex and confusing. Hair loss affects men and women of all ages and frequently has significant social and psychologic consequences. This article reviews the physiology of normal hair growth, common causes of hair loss, and treatments currently available for alopecia.


Eczema is a general term encompassing various inflamed skin conditions. One of the most common forms of eczema is atopic dermatitis (or "atopic eczema"). Approximately 10 percent to 20 percent of the world population is affected by this chronic, relapsing, and very itchy rash at some point during childhood. Although eczema may look different from person to person, it is most often characterized by dry, red, extremely itchy patches on the skin. Eczema is sometimes referred to as "the itch that rashes," since the itch, when scratched, results in the appearance of the rash.

Eczema can occur on just about any part of the body; however, in infants, eczema typically occurs on the forehead, cheeks, forearms, legs, scalp, and neck. In children and adults, eczema typically occurs on the face, neck, and the insides of the elbows, knees, and ankles. In some people, eczema may "bubble up" and ooze. In others, the condition may appear more scaly, dry, and red. Chronic scratching causes the skin to take on a leathery texture because the skin thickens (lichenification).

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